topic Re: Getting switched with little warning into Medicare Advantage in Community Chat

Getting switched with little warning into Medicare Advantage

Marp — Wed, 27 Jul 2016 13:37:13 GMT

THIS COULD BE VERY IMPORTANT INFORMATION FOR STANDARD MEDICARE BENEFICIARIES. PLEASE READ FULL ARTICLE.

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days.

Important information: https://www.washingtonpost.com/national/health-science/senior-surprise-getting-switched-with-little-warning-into-medicare-advantage/2016/07/26/0ed34dd0-533d-11e6-b7de-dfe509430c39_story.html

Re: Getting switched with little warning into Medicare Advantage

RetRN — Wed, 27 Jul 2016 13:43:22 GMT

If you are approaching age 65, you had better pay attention to your mail. A letter was sent and she chose to ignore it. Lesson learned, hopefully.

Re: Getting switched with little warning into Medicare Advantage

Mominohio — Wed, 27 Jul 2016 13:45:49 GMT

Wow. I certainly am no expert on the field of health insurance, but it seems like quite a racket probably designed 'to keep people insured' without loss of coverage as the excuse, but actually another instance where the government messing in the insurance creates havoc for the insured.

There have been a couple of time where we were 'automatically' signed up for something, and shocked when it happened. I think it should be illegal to do, and a signature required before something can be 'automatic' like this. A simple letter informing is not enough.

Re: Getting switched with little warning into Medicare Advantage

judy0330 — Wed, 27 Jul 2016 13:47:19 GMT

Thank you for posting this. I had no idea. As an aside -- several of my doctors have had signs up in their offices for years saying that they accept Medicare but do not accept Medicare Advantage plans. It is important to check about acceptance as well before choosing an Advantage plan.

Re: Getting switched with little warning into Medicare Advantage

151949 — Wed, 27 Jul 2016 13:53:03 GMT

Clearly , this was Blue cross using an excuse of wanting to keep her covered but honestly, anyone who has just started on medicare receives a ton of mail and certainly a person of normal intelligence should be able to recognize that she has gone from regular insurance to medicare and she now needs to look into what she wants to do for supplemental coverage. IMO - the blame for this lies right in this woman's lap. She was irresponsible.

Re: Getting switched with little warning into Medicare Advantage

hopi — Wed, 27 Jul 2016 14:13:19 GMT

Insurance companies are ripping people off and a letter that is not sent certified and explaining what they have done should not be acceptable. There is so much fraud out in the public with older people it is frightening.

Re: Getting switched with little warning into Medicare Advantage

millieshops — Wed, 27 Jul 2016 14:14:40 GMT

I don't like that we can be switched as that article explains, BUT BUT BUT - in the 50+ years I've been taking care of my financial life, I've learned there arer almost no notices I should cavalierly ignore. And were there no uses once that change was made? Seems like I get reports to check on every few weeks. PITA - and I'm basically healthy for someone 10 years on Medicare!

It's fine to worry about $3 and other small amounts, but our lives are most impacted by recurring bills and big messes like the one in that article. I once heard a financial advisor say that most people spend more time choosing a pair of pants than they do working on theirr healthcare choices. I laughed, but it might be true. Thousands of dollars scary.

Re: Getting switched with little warning into Medicare Advantage

Isobel Archer — Wed, 27 Jul 2016 14:18:32 GMT

I guess I am not understanding this.

Having just enrolled in Medicare - and keeping my supplement - I am paying two fees - one to Medicare and one to the supplement.

Doesn't Medicare Advantage just have the one fee?

Wouldn't someone notice this?

What am I missing here?

Re: Getting switched with little warning into Medicare Advantage

tucsongal — Wed, 27 Jul 2016 14:21:33 GMT

Yet another reason why I will never select an "advantage" plan when the time comes.

Re: Getting switched with little warning into Medicare Advantage

nomless — Wed, 27 Jul 2016 14:27:27 GMT

@hopi wrote:
Insurance companies are ripping people off and a letter that is not sent certified and explaining what they have done should not be acceptable. There is so much fraud out in the public with older people it is frightening.

You might not like what the insurance company did and debate can be had whether the practice is acceptable, but equating it to fraud is inaccurate. The insurance company did not engage in fraudulent behavior. The insured party was notified.

Re: Getting switched with little warning into Medicare Advantage

SharkE — Wed, 27 Jul 2016 14:31:02 GMT

Can't do that to me we pay by check. LOL

Re: Getting switched with little warning into Medicare Advantage

millieshops — Wed, 27 Jul 2016 14:37:53 GMT

@Isobel ArcherThe coverages are different between original Medicare and Advantage. Easy to miss.

I have been on original Medicare for 10 years now and plan to stay right there.

The Advantage plans were designed to save money for the taxpayers as I understand it - they do not, and I certainly am not sure how to get the best coverage from them for me as an individual.

Re: Getting switched with little warning into Medicare Advantage

Isobel Archer — Wed, 27 Jul 2016 14:44:37 GMT

@millieshops wrote:
@Isobel ArcherThe coverages are different between original Medicare and Advantage. Easy to miss.

I have been on original Medicare for 10 years now and plan to stay right there.

The Advantage plans were designed to save money for the taxpayers as I understand it - they do not, and I certainly am not sure how to get the best coverage from them for me as an individual.

So then are you saying that you can pay two monthly payments for Medicare Advantage - one to Medicare and another one to the insurance company?

I didn't think it worked like that. I thought Medicare Advantage was handled by the insurance company - e.g., BCBS and you paid them - or Medicare paid them, but in any case you were not responsible to pay BOTH Medicare and BCBS yourself.

Which is why I would think someone would notice the difference. Because clearly, if you thought you had Medicare plus a supplement, you would be paying two payments monthly.

Re: Getting switched with little warning into Medicare Advantage

IamMrsG — Wed, 27 Jul 2016 15:15:57 GMT

This is a very timely post for me and I thank you, @Marp for posting this warning. I will, for one, certainly be aware of this in the next few coming months. You see, I just opted for Medicare A (medical), B (hospital), D (supplemental with United Health) +F (prescription coverage). My private insurance will be dropped soon.

I called my private insurance to inquire as to the best way to let their coverage expire. I considered just not paying the premium, but was concerned it could 'ding' my credit rating. The person I spoke with assured me the credit rating would be unharmed, but cautioned that other complications could come from it.

She said that unless I call to specifically notify them of cancellation, they would just consider me late in paying and would continue coverage, thereby creating double coverage (through them and Medicare, et al). If I had a claim during that first month, there would be complications as to which insurance would cover me.

I do agree with those who think a letter to inform you of being automatically switched to Advantage is not enough and shouldn't be legal. The inordinate amount of (imho,) junk mail and phone calls (!!) I am receiving as my 65th birthday nears is astounding. After I've made my decisions and have enrolled into the plan(s) I've chosen, I should be done with all this nonsense. As I see this is not necessarily so, I thank you again, @Marp, for the "heads up!".

Edited to correct an error.

Re: Getting switched with little warning into Medicare Advantage

Allegheny — Wed, 27 Jul 2016 15:06:47 GMT

@Marp Thank you very much for posting this. It is valuable information. May-be I am in the minority with my opinion here, but I feel this is very wrong.

If I understand the article correctly, this woman selected traditional Medicare as her primary. After that election, no existing/previous insurer should have the ability to switch her election.

I believe practices like this are knowingly taking advantage of people who may not be that informed or as in her case, felt they made their decision and no further action was required.

It should not be an "opt out" selection rather an "opt in".

Re: Getting switched with little warning into Medicare Advantage

Moonchilde — Wed, 27 Jul 2016 15:18:00 GMT

@tucsongal wrote:
Yet another reason why I will never select an "advantage" plan when the time comes.

I initially wanted a MA plan - they have some great features - but one is not available in the area I live in; can't get one here. So I had to go with traditional Medicare and supplement. The more the months go by and I read the various DISadvantages of MA, the more I'm now quite content with things as they are.

However - I had BX/BS while working, lived at the time in a huge metropolitan area with choice of any MA plan out there, and I never had any such notification letter tried on me before I moved, while I was in the process of obtaining SS and Medicare. But then, I was working until age 66-1/2, and had initiated traditional Medicare and supplement to kick in *right* after my last day of work. I got COBRA notifications, but nothing in the mail like described in the OP. They must target people in a specific category, but what ?

Re: Getting switched with little warning into Medicare Advantage

software — Wed, 27 Jul 2016 15:22:42 GMT

Thanks for posting. Besides all the posts about not ignoring your mail, didn't the facility have some responsibility in verifying the patient's insurance?

I always demand my doctor's office do the pre-cert if necessary and before I have any procedure, I make sure the facility has done their due diligence as it relates to my coverage.

It's not rocket science but it can be high maintenance.

@Marp wrote:
THIS COULD BE VERY IMPORTANT INFORMATION FOR STANDARD MEDICARE BENEFICIARIES. PLEASE READ FULL ARTICLE.

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

Neither the plan nor Medicare now would cover her medical costs. She owed $16,622.

“I was panicking,” said Hanttula, who lived in Carlsbad, N.M., at the time. After more than five hours making phone calls, she learned that because she’d had individual coverage through Blue Cross Blue Shield when she became eligible for Medicare, the company automatically signed her up for its own Medicare Advantage plan after notifying her in a letter. Hanttula said she ignored all mail from insurers because she had chosen traditional Medicare.

“I felt like I had insured myself properly with Medicare,” she said. “So I quit paying attention to the mail.”

With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called “seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days.

Important information: https://www.washingtonpost.com/national/health-science/senior-surprise-getting-switched-with-little-warning-into-medicare-advantage/2016/07/26/0ed34dd0-533d-11e6-b7de-dfe509430c39_story.html

Re: Getting switched with little warning into Medicare Advantage

phoenixbrd — Wed, 27 Jul 2016 15:45:33 GMT

Thank you for this posting this.....this is critical information for me.

Re: Getting switched with little warning into Medicare Advantage

151949 — Wed, 27 Jul 2016 16:10:13 GMT

@Isobel Archer wrote:
@millieshops wrote:
@Isobel ArcherThe coverages are different between original Medicare and Advantage. Easy to miss.

I have been on original Medicare for 10 years now and plan to stay right there.

The Advantage plans were designed to save money for the taxpayers as I understand it - they do not, and I certainly am not sure how to get the best coverage from them for me as an individual.
So then are you saying that you can pay two monthly payments for Medicare Advantage - one to Medicare and another one to the insurance company?

I didn't think it worked like that. I thought Medicare Advantage was handled by the insurance company - e.g., BCBS and you paid them - or Medicare paid them, but in any case you were not responsible to pay BOTH Medicare and BCBS yourself.

Which is why I would think someone would notice the difference. Because clearly, if you thought you had Medicare plus a supplement, you would be paying two payments monthly.

Actually, in some cases people ONLY pay the medicare fee that is deducted from their SS check for a medicare advantage plan, and others have to pay that deduction from their SS check and a premium to the ins co. Anyway it goes - it is certainly on the individual to know what is going on with their own insurance.

Re: Getting switched with little warning into Medicare Advantage

Tinkrbl44 — Wed, 27 Jul 2016 16:19:41 GMT

@hopi wrote:
Insurance companies are ripping people off and a letter that is not sent certified and explaining what they have done should not be acceptable. There is so much fraud out in the public with older people it is frightening.

@hopi

Sorry, but your comments are just not accurate.

ANYONE who has had health insurance through an employer should be familiar with the concept of Open Enrollment, and what that means. In some instances you need to re-enroll every year, and in other cases you just do nothing. However, Open Enrollment means re-evaluating all your coverage. Simple concept.

When someone is transitioning to Medicare, it is THEIR responsibility to evaluate the options and compare coverage. It's also wise to make sure the MD or facility has the authorization before any procedures are done. If they don't do that, how can you blame the insurance company? It's not their fault!

This woman deliberately ignored notifications in her mail. Who does that?

It's unfortunate this happened, but you can't blame any insurance company for this outcome.